Using data from an active population-based surveillance system, Klevens and colleaguesArticle assessed the incidence and distribution of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections in 9 US communities, classified the infections as either health care associated or community associated and estimated the burden of invasive MRSA infections in the United States in 2005. They found a standardized incidence rate of 31.8 per 100 000 persons and estimate that 94 360 infections occurred in 2005, of which 18 650 were potentially fatal. Most infections were health care associated, but 58% occurred outside of the hospital, caused by strains commonly attributed to both community and health care sources. In an editorial, BancroftArticle discusses the increasing problem of infections caused by antimicrobial-resistant organisms and the need for more effective prevention strategies.
Cases of invasive pneumococcal disease have declined since introduction of the 7-valent pneumococcal conjugate vaccine (PCV7), but the emergence of multidrug-resistant non-PCV7 strains has been noted. In a prospective cohort study of 1816 children who had received PCV7 and who were diagnosed with acute otitis media between September 2003 and June 2006, Pichichero and CaseyArticle determined the serotypes and antibiotic susceptibility of Streptococcus pneumoniae cultured from middle ear fluid obtained by tympanocentesis. Of the 212 procedures performed, 59 yielded S pneumoniae. One novel strain belonging to serotype 19A was identified in 9 cases and was resistant to antibiotics approved for children with acute otitis media. In an editorial, BancroftArticle discusses community-based surveillance for antibiotic resistance and identification of the resistant strains.
Institutional academic–industry relationships (IAIRs) exist when an academic institution or senior officials of an institution have a financial interest in a public or private company. Whether IAIRs pose conflicts of interest is not clear. In an national survey of department chairs, Campbell and colleagues examined the nature, extent, and consequences of IAIRs for medical schools and teaching hospitals. The authors report that 60% of department chairs had some form of personal relationship with industry. Sixty-seven percent of departments as administrative entities had relationships with industry, receiving financial and in-kind support. A majority of department chairs responded that IAIRs—either personal or departmental—did not have a negative effect on departmental activities.
Boyle discusses cystic fibrosis in adults including the variability in disease severity and effectiveness of newer therapies in the case of Mr Y, a 52-year-old man who was diagnosed with cystic fibrosis at age 3 years but experienced few activity-limiting symptoms or serious health consequences until his 40s.
Why does a 63-year-old man with multiple cardiovascular risk factors not adhere to his evidence-based treatment regimen? In the JAMA section Clinical Crossroads, an expert discussant considers a patient who faces a crossroads in medical care and discusses the pros and cons of diagnostic or treatment options. Now you can formulate and submit your own opinion before the expert, with the possibility that your response will be posted online with the article. Go to www.jama.com and submit your response. Responses should be submitted by October 31.
“Had I been honest with myself, I would have recognized that I had missed Papa long before he died.” From “The Family Man.”
Emerging evidence supports the use of medication to treat preschool children with severe attention-deficit/hyperactivity disorder but also indicates that close monitoring for adverse events is necessary in this group.
Association of severe mental illness with excess morbidity and premature mortality due to cardiovascular disease (CVD).
Similarities between pay for performance (P4P) and fee for service (FFS) reimbursement systems.
A proposal for improving measurement and reporting of health care quality.
Join R. Monica Klevens, DDS, MPH, November 21 from 2 to 3 PM eastern time to discuss invasive methicillin-resistant Staphylococcus aureus infections. To register, go to http://www.ihi.org/AuthorintheRoom.
For your patients: Information about methicillin-resistant Staphylococcus aureus infections.
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl.
This Week in JAMA . JAMA. 2007;298(15):1733. doi:10.1001/jama.298.15.1733